Minisymposium Emerging issues in public health: A perspective on China’s healthcare system R.E. Ling a,b , F. Liu a , X.Q. Lu a , W. Wang a,c,d, * a School of Public Health and Family Medicine, Capital Medical University, Beijing, China b University of Oxford, Medical School, John Radcliffe Hospital, Oxford, UK c Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia d College of Life Sciences, Graduate University, Chinese Academy of Sciences, Beijing, China article info Article history: Available online 17 December 2010 Keywords: China Healthcare systems Healthcare reform summary China’s expenditure on healthcare has increased dramatically over the last 20 years, and three broad trends are seen in the associated health outcomes. First, limited improvements have been achieved to aggregate high-level health outcomes, e.g. infant mortality. Second, development of large and widening health inequalities associated with disparate wealth between provinces and a ruraleurban divide. Finally, the burden of disease is shifting from predominantly communicable diseases to chronic diseases. Reasons for the limited gains from investment in healthcare are identified as: (1) increased out-of-pocket expenditure including a high proportion of catastrophic expenditure; (2) a geographical imbalance in healthcare spending, focusing on secondary and tertiary hospital care and greater expenditure on urban centres compared with rural centres; and (3) the commercialization of healthcare without adequate attention to cost control, which has led to escalation of prices and decreased efficiency. Recently, the Chinese Government has initiated wide- spread reform. Three key policy responses are to establish rural health insurance, partly funded by the Government (the New Rural Co-operative Medical Care System); to develop community health centres; and to aspire to universal basic healthcare coverage by 2020 (Healthy China 2020). ª 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. Introduction China’s economy has experienced unprecedented growth over the last 30 years. These vast increases in wealth have allowed expenditure on healthcare to rise at even faster rates. Total health expenditure increased from 1.1 billion Yuan in 1978 to 1128.9 billion Yuan in 2007, equating to approximately a 75-fold increase in health expenditure per head. 1 It is likely that this represents the biggest single increase in per capita health expenditure at any point in history. It is therefore of interest to consider what benefits such investment has delivered, why this is the case, and what could and should be done differently. Over the last 20 years, China’s health outcomes have exhibited three broad features: relatively small improvements * Corresponding author. College of Life Sciences, Graduate University, Chinese Academy of Sciences, Beijing 100049, China. Tel.: þ86 10 83911504; fax: þ86 10 83911501. E-mail address: wei6014@gucas.ac.cn (W. Wang). available at www.sciencedirect.com Public Health journal homepage: www.elsevier.com/puhe public health 125 (2011) 9 e14 0033-3506/$ e see front matter ª 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2010.10.009